The present invention is directed toward a laparoscopic suturing guide and more particularly, toward such a laparoscopic suturing guide that allows a surgeon to quickly and accurately suture a port after laparoscopic or endoscopic surgery and without inadvertently also suturing the dermis.
As is well known in the art, an endoscopic or laparoscopy procedure involves making small surgical incisions in a patient's body for the insertion of trocar tubes thereby creating access ports into the patient's body. Various types of endoscopic or laparoscopic instruments are passed through these access ports and the appropriate surgical procedures are carried out.
After the surgical procedure is performed, the trocar tubes are removed and the incisions sutured closed by using a needle and grasper for penetrating the tissue and handling the suture. This procedure for closure is frequently time-consuming requiring the identification of the fascia and closure of each fascial site with suture from an external point.
The necessity for properly closing these port sites, particularly in laparoscopic surgery, is critical since suturing the incisions improperly can lead to bowel herniation through the port sites as well as the possibility of omental trapping if the fascial sites are not properly closed. Incisional hernias have occurred in both laparoscopic-assisted vaginal hysterectomies and laparoscopic cholecystectomies as well as other advanced laparoscopic procedures.
At present, two methods of wound suturing upon the removal of the ports are known. According to one of them, the wound is sutured manually with the help of surgical thread-guiding members such as clamp needles and without any special devices. This method is highly traumatizing and labor-consuming as the selection of the right directions of the thread-guiding members inserted through the abdominal or thoracic wall into the pre-specified points of the body requires quite a considerable amount of time.
The other method involves the use of special devices or guides which diminish the traumatizing effect of wound suturing and the amount of labor required. One such device is described, for example, in U.S. Pat. No. 5,507,758 that issued to Thomason et al. in 1996.
The Thomason et al. guide comprises a cylindrical main section which at its proximal end comprises a disk-like projection. The cylindrical section of the guide is inserted into the port until the peripheral projection at the proximal end bears as an abutment on the outer side of the tissue, i.e. on the surface of the skin. Two obliquely running through-holes are formed in the inside of the cylindrical section, so that instruments for suturing may be introduced from the proximal end-face of the guide into the through-holes. The through-holes are opened to the peripheral outer wall of the cylindrical section, such that instruments used for suturing enter the tissue through an exit hole and penetrate this tissue in order to suture.
While the Thomason et al. device has met with some success, it is not completely satisfactory. When closing the port, it is necessary to initially suture only the abdominal or the thoracic wall or the peritoneum facia and to avoid the suturing needle from passing through the epidermis or the dermis or other layer of skin. This is sometimes difficult to do with the use of the Thomason et al. device since the disk-like projection at the top or proximal end covers the site and prevents the surgeon from properly viewing the same. As a result, the surgeon closing the port cannot see precisely where the suture needle is entering the port and it sometimes occurs that the needle enters too high and passes through the dermis.
A need exists, therefore, for a laparoscopic suturing guide that allows a surgeon to quickly and accurately suture a port after laparoscopic or endoscopic surgery.